Resource utilization and economic outcomes following repetitive transcranial magnetic stimulation for treatment-resistant depression: a retrospective observational analysis.
Level 3 - non-randomized controlled study
Propensity score-matched retrospective observational cohort study using administrative claims data.
PubMed 40491267 · doi:10.57264/cer-2025-0019
What was done
A retrospective observational cohort study evaluated healthcare resource utilization and payer costs among patients with treatment-resistant depression. Using Medicare Fee-for-Service and commercial (Merative MarketScan) claims data from January 1, 2021, to September 30, 2023, investigators compared an 18-month cohort receiving repetitive transcranial magnetic stimulation (rTMS) to a non-rTMS cohort after propensity score matching. Endpoints included inpatient admissions, emergency room visits, hospital outpatient visits, and payer-allowed costs.
What was found
Compared with the non-rTMS group, the rTMS group showed: - 37% more hospital outpatient visits (14.00 vs 10.21; p ≤ 0.0001) with non-significantly higher outpatient costs ($8,946 vs $8,363; p = 0.3400). - 24% fewer inpatient admissions (0.25 vs 0.33; p = 0.0003) with 19% lower inpatient costs ($5,666 vs $6,978; p = 0.0392). - 48% fewer emergency room visits (0.27 vs 0.53; p ≤ 0.0001) with 34% lower emergency room costs ($322 vs $487; p ≤ 0.0001). - An overall reduction of $893 in episode-of-care costs.
Why it matters
This suggests the higher upfront outpatient burden of rTMS delivery is offset by reductions in high-acuity, high-cost emergency and inpatient healthcare utilization.
Limits
The abstract does not state the total sample size (n). As a retrospective claims database analysis, the study is vulnerable to residual confounding, coding errors, and an absence of direct clinical outcome measures such as symptom severity, functional improvement, or adverse events.
Cited by
- supports Repetitive transcranial magnetic stimulation (rTMS) is FDA-approved for depression and is covered by Medicare.